MEDICARE: ATHLETICO, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1457601163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICO, LTD

Provider Business Mailing Address
First Line	:	555 E TOWNLINE RD
Second Line	:	SUITE 24
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1552
Country	:	US
Telephone Number	:	847-573-0051
Fax Number	:	847-573-0345

Provider Business Practice Location Address
First Line	:	555 E TOWNLINE RD
Second Line	:	SUITE 24
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1552
Country	:	US
Telephone Number	:	847-573-0051
Fax Number	:	847-573-0345

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	GERI COOK
Credential	:
Telephone Number	:	630-575-1940

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/22/2014

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Directions to “ATHLETICO, LTD ” Practice Location

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